What about the IPAB?

Nov. 29, 2016
There has been a massive political push to repeal and replace the Affordable Care Act, but how will it affect dermatology? While the American Academy of Dermatology Association (AADA) was concerned with the ACA when it was implemented, it redirected its focus to improving the law so that it does not undermine patients’ access to dermatologic care. Specifically, the AADA continues to call for repeal of the Independent Payment Advisory Board (IPAB) — instituted as part of the ACA — which consists of a 15-member panel of appointed officials that are tasked with containing Medicare costs if costs exceed certain levels. Currently, no members have been appointed and spending has not yet exceeded the target at which recommendations would be required. However, “Current predictions indicate that 2017 Medicare spending will trigger cuts in 2019,” said Michelle Mathy, assistant director of political and congressional affairs at the AADA. 

According to Mathy, one major challenge in repealing the IPAB, however, is that Republicans will want to offset the cost of repeal — which has a price tag of about $13 billion. Coming up with such offsets has been one of the chief difficulties in passing legislation in recent years. Additionally, Trump has not specifically expressed an opinion either way on IPAB. If the full ACA is repealed, the IPAB would be repealed as well.

If the ACA is not repealed, the IPAB would have to be addressed on its own. If Republicans use the reconciliation process ― which gets around the 60-vote filibuster threshold and can only be used for legislation that affects the deficit ― things get complicated. “When the Republican Congress voted to repeal parts of the ACA under the reconciliation process last year, the Senate parliamentarian ruled that the provision to repeal IPAB violated the Byrd Rule which requires reconciliation bills to have a budgetary impact,” said Christine O’Connor, AADA associate director of congressional policy. “As a result of that ruling the provision was removed from the bill.” Essentially, the IPAB would have to be addressed and repealed in a separate bill ― a possibility given that repeal of the IPAB has garnered bipartisan support.

Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.